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Data Management Request

Under the California Consumer Privacy Act and the California Privacy Rights Act, hereinafter “CCPA/CPRA,” California residents have the right to opt out of the sale of their personal information.

TDC Group gathers information to improve the online experience, deliver requested content, and provide optimal service to our members, prospective members, and agents.

We recognize the importance of respecting and safeguarding your data, and we are committed to providing you with data privacy choices. If you wish to opt out, delete, or access your personal information maintained by TDC Group, please complete the form below or call us at (800) 421-2368. Because we often hold very sensitive information, we will need to verify who is making this request.

For more information, please read our privacy policy.

Identity of Requestor

I,
,
am the person submitting the request regarding my own data
I,
,
am an agent of

Capacity of Consumer

Request Type

Consumer Information

Name of Group/Entity (if applicable):
Policy Number (if applicable):
Billing Account Number (if applicable):
Claim Number (if applicable):
Date of Birth:
SSN (last four digits):
Mailing Address:
City:
State:
ZIP Code:
Email Address:
Phone Number:
Preferred Contact Method:
The above information is being collected to identify and verify the person making the request and to demonstrate adherence to the requirements of the CCPA/CPRA and will be maintained only for that purpose.
I hereby certify that I am the person whose name is set out below and that I am authorized to make this request. I understand that making unauthorized requests made in the name of another person may subject me to civil and criminal penalties and that if TDC Group discovers an authorized or fraudulent request made pursuant to the provisions of the CCPA/CPRA, it will be the policy of TDC Group to report such conduct and assist in any prosecution that may ensue.
Authorized Requestor’s Signature:

If we are unable to verify your information, we will not be able to complete your request. If you have any questions, please contact Member Services at (800) 421-2368.

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